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PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer

  • Amy R. DeipolyiEmail author
  • Ryan W. England
  • Fourat Ridouani
  • Christopher C. Riedl
  • Henry S. Kunin
  • F. Edward Boas
  • Hooman Yarmohammadi
  • Constantinos T. Sofocleous
Clinical Investigation Imaging
Part of the following topical collections:
  1. Imaging

Abstract

Purpose

To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE).

Materials and Methods

From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%.

Results

Of the 68 post-RE scans, 6 were performed at 0–30 days, 15 at 31–60 days, 9 at 61–90 days, 13 at 91–120 days, 14 scans at 121–180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30–90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders.

Conclusion

In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30–90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.

Keywords

Breast cancer Radioembolization Liver metastasis PET/CT imaging 

Notes

Funding

This research was partly funded through the NIH/NCI Cancer Center Support Grant P30 CA008748 and the Breast Cancer Research Foundation.

Compliance with Ethical Standards

Conflict of interest

Dr. Deipolyi reports personal fees from BTG, Inc., personal fees from Dova Pharmaceuticals, outside the submitted work. Dr. Boas is a co-founder of Claripacs, LLC, and received a research grant and supplies from Guerbet, research support from GE, research supplies from Bayer, and a research grant and speaker fees from Society of Interventional Oncology, sponsored by Guerbet; he is also an investor in Labdoor, Qventus, CloudMedx, Notable Labs, and Xgenomes. Dr. Yarmohammadi received research grants from the Thompson Foundation and Guerbet. Dr. Sofocleous received consulting fees from Terumo and consulting fees and research funding from BTG and Johnson and Johnson. The other authors have no disclosures.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.

Informed Consent

This study has obtained institutional IRB approval, and the need for informed consent was waived due to its retrospective nature.

Consent for Publication

For this type of study, consent for publication is not required.

References

  1. 1.
    Lewandowski RJ, Salem R. Yttrium-90 radioembolization of hepatocellular carcinoma and metastatic disease to the liver. Semin Intervent Radiol. 2006;23:064–72.CrossRefGoogle Scholar
  2. 2.
    Bhangoo MS, Karnani DR, Hein PN, et al. Radioembolization with Yttrium-90 microspheres for patients with unresectable hepatocellular carcinoma. J Gastrointest Oncol. 2015;6:469.PubMedPubMedCentralGoogle Scholar
  3. 3.
    De Souza A, Daly KP, Yoo J, Saif MW. Safety and efficacy of combined yttrium 90 resin radioembolization with aflibercept and FOLFIRI in a patient with metastatic colorectal cancer. Case reports in oncological medicine. 2015.Google Scholar
  4. 4.
    Saxena A, Kapoor J, Meteling B, Morris DL, Bester L. Yttrium-90 radioembolization for unresectable, chemoresistant breast cancer liver metastases: a large single-center experience of 40 patients. Ann Surg Oncol. 2014;21:1296–303.CrossRefGoogle Scholar
  5. 5.
    Vouche M, Kulik L, Atassi R, et al. Radiological-pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: imaging analysis from a prospective randomized trial of Y90 ± sorafenib. Hepatology. 2013;58:1655–66.CrossRefGoogle Scholar
  6. 6.
    Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K. Response criteria in oncologic imaging: review of traditional and new criteria. Radiographics. 2013;33:1323–41.CrossRefGoogle Scholar
  7. 7.
    Sofocleous CT, Violari EG, Sotirchos VS, et al. Radioembolization as a salvage therapy for heavily pretreated patients with colorectal cancer liver metastases: factors that affect outcomes. Clin Colorectal Cancer. 2015;14:296–305.CrossRefGoogle Scholar
  8. 8.
    Fernandez-Ros N, Inarrairaegui M, Paramo JA, et al. Radioembolization of hepatocellular carcinoma activates liver regeneration, induces inflammation and endothelial stress and activates coagulation. Liver Int. 2015;35:1590–6.CrossRefGoogle Scholar
  9. 9.
    Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.CrossRefGoogle Scholar
  10. 10.
    Zerizer I, Al-Nahhas A, Towey D, et al. The role of early (1)(8)F-FDG PET/CT in prediction of progression-free survival after (9)(0)Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging. 2012;39:1391–9.CrossRefGoogle Scholar
  11. 11.
    Edalat F, Camacho JC, Kokabi N, Kendi AT, Galt JR, Kim HS. Standardized added metabolic activity predicts survival after intra-arterial resin-based 90Y radioembolization therapy in unresectable chemorefractory metastatic colorectal cancer to the liver. Clin Nucl Med. 2016;41:e76–81.CrossRefGoogle Scholar
  12. 12.
    Fendler WP, Tiega DBP, Ilhan H, et al. Validation of several SUV-based parameters derived from 18F-FDG PET for prediction of survival after SIRT of hepatic metastases from colorectal cancer. J Nucl Med. 2013;54:1202–8.CrossRefGoogle Scholar
  13. 13.
    Grut H, Dueland S, Line PD, Revheim ME. The prognostic value of (18)F-FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases. Eur J Nucl Med Mol Imaging. 2018;45:218–25.CrossRefGoogle Scholar
  14. 14.
    Jongen JMJ, Rosenbaum C, Braat M, et al. Anatomic versus metabolic tumor response assessment after radioembolization treatment. J Vasc Interv Radiol. 2018;29(244–53):e2.Google Scholar
  15. 15.
    Jreige M, Mitsakis P, Van Der Gucht A, et al. (18)F-FDG PET/CT predicts survival after (90)Y transarterial radioembolization in unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2017;44:1215–22.CrossRefGoogle Scholar
  16. 16.
    Piduru SM, Schuster DM, Barron BJ, Dhanasekaran R, Lawson DH, Kim HS. Prognostic value of 18f-fluorodeoxyglucose positron emission tomography-computed tomography in predicting survival in patients with unresectable metastatic melanoma to the liver undergoing yttrium-90 radioembolization. J Vasc Interv Radiol. 2012;23:943–8.CrossRefGoogle Scholar
  17. 17.
    Sabet A, Meyer C, Aouf A, et al. Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer. Eur J Nucl Med Mol Imaging. 2015;42:370–6.CrossRefGoogle Scholar
  18. 18.
    Shady W, Kishore S, Gavane S, et al. Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after (90)Y radioembolization of colorectal liver metastases: a comparison with SUVmax, SUVpeak, and RECIST 1.0. Eur J Radiol. 2016;85:1224–31.CrossRefGoogle Scholar
  19. 19.
    Shady W, Sotirchos VS, Do RK, et al. Surrogate imaging biomarkers of response of colorectal liver metastases after salvage radioembolization using 90Y-loaded resin microspheres. AJR Am J Roentgenol. 2016;207:661–70.CrossRefGoogle Scholar
  20. 20.
    Riedl C, Pinker K, Ong L, et al. Comparison of FDG-PET/CT with contrast enhanced CT for prediction of progression-free and disease-specific survival in stage IV breast cancer patients: a retrospective analysis. J Nucl Med. 2015;56:1320.Google Scholar
  21. 21.
    Riedl CC, Pinker K, Ulaner GA, et al. Comparison of FDG-PET/CT and contrast-enhanced CT for monitoring therapy response in patients with metastatic breast cancer. Eur J Nucl Med Mol Imaging. 2017;44:1428–37.CrossRefGoogle Scholar
  22. 22.
    National Comprehensive Cancer Network. Breast Cancer. Version 2.2017.Google Scholar
  23. 23.
    Deipolyi AR, Riedl CC, Bromberg J, et al. Association of PI3K pathway mutations with early positron-emission tomography/CT imaging response after radioembolization for breast cancer liver metastases: results of a single-center retrospective pilot study. J Vasc Interv Radiol. 2018;29:1226–35.CrossRefGoogle Scholar
  24. 24.
    Jh O. Practical PERCIST: a simplified guide to PET response criteria in solid tumors 1.0. Radiology. 2016;280:576–84.CrossRefGoogle Scholar
  25. 25.
    Hickey R, Lewandowski RJ, Prudhomme T, et al. 90Y radioembolization of colorectal hepatic metastases using glass microspheres: safety and survival outcomes from a 531-patient multicenter study. J Nucl Med. 2016;57:665–71.CrossRefGoogle Scholar
  26. 26.
    Kennedy AS, Ball D, Cohen SJ, et al. Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres. J Gastrointest Oncol. 2015;6:134–42.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Kurilova I, Beets-Tan RGH, Flynn J, et al. Factors affecting oncologic outcomes of 90Y radioembolization of heavily pre-treated patients with colon cancer liver metastases. Clin Colorectal Cancer. 2019;18:8–18.CrossRefGoogle Scholar
  28. 28.
    Rhee TK, Naik NK, Deng J, et al. Tumor response after yttrium-90 radioembolization for hepatocellular carcinoma: comparison of diffusion-weighted functional MR imaging with anatomic MR imaging. J Vasc Interv Radiol. 2008;19:1180–6.CrossRefGoogle Scholar
  29. 29.
    Kallini JR, Miller FH, Gabr A, Salem R, Lewandowski RJ. Hepatic imaging following intra-arterial embolotherapy. Abdom Radiol (NY). 2016;41:600–16.CrossRefGoogle Scholar
  30. 30.
    Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional therapies for the treatment of hepatic metastases from breast and gynecologic cancers. Seminars in interventional radiology. New York: Thieme Medical Publishers; 2018. p. 29–034.Google Scholar
  31. 31.
    Gordon AC, Gradishar WJ, Kaklamani VG, et al. Yttrium-90 radioembolization stops progression of targeted breast cancer liver metastases after failed chemotherapy. J Vasc Interv Radiol. 2014;25:1523–32.CrossRefGoogle Scholar
  32. 32.
    Haug AR, Tiega Donfack BP, Trumm C, et al. 18F-FDG PET/CT predicts survival after radioembolization of hepatic metastases from breast cancer. J Nucl Med. 2012;53:371–7.CrossRefGoogle Scholar
  33. 33.
    Vouche M, Habib A, Ward TJ, et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology. 2014;60:192–201.CrossRefGoogle Scholar
  34. 34.
    Spreafico C, Maccauro M, Mazzaferro V, Chiesa C. The dosimetric importance of the number of 90 Y microspheres in liver transarterial radioembolization (TARE). Eur J Nucl Med Mol Imaging. 2014;41:634–8.CrossRefGoogle Scholar
  35. 35.
    Ziv E, Bergen M, Yarmohammadi H, et al. PI3K pathway mutations are associated with longer time to local progression after radioembolization of colorectal liver metastases. Oncotarget. 2017;8:23529–38.CrossRefGoogle Scholar
  36. 36.
    Barabasch A, Kraemer NA, Ciritsis A, et al. Diagnostic accuracy of diffusion-weighted magnetic resonance imaging versus positron emission tomography/computed tomography for early response assessment of liver metastases to Y90-radioembolization. Invest Radiol. 2015;50:409.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Amy R. Deipolyi
    • 1
    Email author
  • Ryan W. England
    • 1
  • Fourat Ridouani
    • 1
  • Christopher C. Riedl
    • 2
  • Henry S. Kunin
    • 1
  • F. Edward Boas
    • 1
  • Hooman Yarmohammadi
    • 1
  • Constantinos T. Sofocleous
    • 1
  1. 1.Interventional Radiology ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Molecular Imaging and Therapy ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

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